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GOOD SAMARITAN HOSP CORVALLIS
DSH380022 SAMARITAN ALBANY GENERAL HOSPITAL
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Covered Entity Details
Entity Name
SAMARITAN ALBANY GENERAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH380022
Entity Address
1046 6TH AVE SW
ALBANY, OR 97321
Medicare Provider Number
380022
Participating Start Date
4/1/2012
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
GOOD SAMARITAN HOSP CORVALLIS
Pharmacy Address
DBA: SAMARITAN PHARMACY SERVICES
3521 NW SAMARITAN DR
STE 202
CORVALLIS, OR 97330
Pharmacy Comments
Contract Details
Approval Date
4/2/2013
Contract Begin Date
4/20/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DANIEL B. SMITH, VP FINANCE/CFO
(541) 768-5390
Contract Pharmacy Representative
Samaritan Health Services
Cody Aichele, Outpatient Pharmacy Supervisor
(541) 768-6095
Signed By Date
4/27/2012
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